Talk:Anemia of chronic disease

iron deficiency

The article states "In anemia of chronic disease without iron deficiency, ferritin levels should be normal or high, reflecting the fact that iron is stored within cells, and ferritin is being produced as an acute phase reactant but the cells are not releasing their iron. In iron deficiency anemia ferritin should be low." This is wrong. Ferritin is an acute-phase responder. Ferritin indicates storage iron, and as part of immune defence, iron will be locked away in storage to keep bacteria from using iron in replication. Thus, ferritin in ACD is usually normal or even high, especially when the ACD comes with a strong inflammation. This does not mean that iron is available for erythropoiesis, and thus the anaemia is still an iron-deficiency anaemia - it's called "functional iron deficiency" in the literature. See also Wish, Clin J Am Soc Nephrol 1: S4–S8, 2006. The parameter of choice would rather be reticulocyte haemoglobin content, which directly mirrors the iron available for erythropoiesis. The suggestion "Examination of the bone marrow to look for the absence or presence of iron ... can provide more definitive diagnoses." is outdated and advocates unnecessarily invasive procedures. Guidelines by now include the percentage of hypochromic red cells and the reticulocyte haemoglobin content to assess the role of iron in anaemia. They're available from routine blood samples without any need for bone marrow analysis. --16:29, 2 December 2008 (UTC)

multiple mechanisms of anemia in inflammation

The discussion implies that functional iron deficiency mediated by hepcidin is the sole mechanism of anemia of chronic disease. Other mechanisms are overlooked, which include the direct suppression of erythropoietic cells by inflammatory cytokines, the suppression of erythropoietin release by the kidney, and the reduction in red cell survival.DonaldSHouston (talk) 04:22, 18 December 2008 (UTC)

Evolutionary Considerations

I've added a brief section on evolutionary considerations on the topic. Any feedback would be appreciated. Argentum42 (talk) 21:13, 2 December 2013 (UTC)

I have deleted references 7 and 8:they speak only to dietary iron deficiency, not anemia of chronic disease. Further, the theory that a mechanism to restrict iron availability to bacteria has survival value is certainly plausible, but not of sufficient importance to warrant a separate section.

IiKkEe (talk) 23:47, 30 September 2014 (UTC)

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Removing unsourced sentence

The unsourced sentence "Anemia of chronic inflammation is the preferred term since not all chronic diseases are associated with this form of anemia." was added in 2014 by an editor who was subsequently blocked indefinitely after an ANI discussion on their inaccurate editing of medical articles. I have googled "anemia of chronic infection" plus "preferred" and found nothing. I think we can safely remove this sentence. It can of course be replaced if anyone finds a reference to support it (in which case the article should probably be moved). PamD 08:13, 22 June 2022 (UTC)